What is meant by ‘DDC’?
How prevalent is DDC?
How does DDC impact me as a nurse?
Are there health effects of DDC?
Why is DDC important to understand?
How could DDC affect my work?
How could being a nurse affect the care that I provide to my older relative?
Are there professional nursing standards that address DDC?
KT FAQ

What is meant by ‘DDC’?

Within the health professions many people are believed to be "double duty caregivers" (DDCs) – those individuals who provide care both at home and at work. In keeping with the notion that informal can look very differently depending on the population (i.e. childcare, care for friends and neighbors), our studies investigate the health of effects of nurses' providing informal care for elderly relatives.

How prevalent is DDC?

Although the prevalence of double duty caregiving (DDC) is currently unknown, research has shown that approximately 30-50% of the working population provides care to older relatives, with most care being provided by female family members. Additionally, research suggests that approximately one half of health professionals provide care to an older relative(s).

How does DDC impact me as a nurse?

Although there is some evidence to suggest that employed family caregivers of elderly adults experience strain of balancing work and family responsibilities, we know very little about the health effects of combining familial and professional caregiving, However, our studies to date suggest that the blurring of family and professional care boundaries often result in poor health experiences.

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Are there health effects of DDC?

Our previous qualitative study suggested that a dramatic blurring or erosion of boundaries between personal and professional caregiving amongst female health professionals resulted in negative health experiences such as feelings of isolation, and mental and physical exhaustion. Thus, in response to these findings and an expressed need by health professional organizations to determine the extent and impact of DDC we developed and pilot tested the DDC Scale, which measures Expectations, Supports, Setting Limits, Making Connections and Caregiving Interface. In this pilot study of female nurses, we found that Caregiving Interface negatively correlated with caregiver well being and with health outcomes. Our most recent study findings yielded that DDCs reported lower health outcomes compared to non-DDCs. Furthermore, qualitative data analysis revealed that DDCs tended to professionalize their familial care. Embedded within two overarching processes, setting limits and making connections, six sub-processes emerged: assessing, advising, advocating, collaborating, coordinating and consulting. Each of these strategies assisted DDCs to respond to familial care expectations and care resources. For those DDCs with high expectations and limited resources, the boundaries between professional and personal care domains blurred, taking a toll on their health.

Why is DDC important to understand?

Developing a more comprehensive understanding of DDC is particularly urgent in a time of health care reform and shortages of registered nurses (RNs) and other health care providers. Additionally, as our population continues to grow older and the average age of a nurse increases, the phenomenon of DDC is predicted to become even more pronounced. If nurses are double duty caregivers it may affect their job, their family, their older relative and their health. It is important to know what potential supports and resources exist to support double duty caregivers, such as workplace or community supports.

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How could DDC affect my work?

Our findings suggest that being a DDC has both positive and negative effects on care work. For example, some of the positive health effects identified by nurses are that some nurses felt that being a DDC has enhanced their understanding of some of the challenges family caregivers experience when navigating the health care system. Other nurses have related to the experience of providing care to older adults in their work environment. Some of negative health experiences were described as lacking workplace supports, such as inflexible work schedules and strict policies related to absenteeism.

How could being a nurse affect the care that I provide to my older relative?

Our analysis yielded that some nurses perceive their professional role as an asset for providing quality care 'at home', with specialized knowledge and professional connections many described their nursing background as a resource. Consequently, some nurses described the expectations affiliated with their professional role, indicating that there is additional responsibility to provide care. These nurses can feel conflicted when the expectations to provide care outweigh the supports to assist them with the provision of care.

Are there professional nursing standards that address DDC?

Many nurses are unaware of the professional standards related to the practice of providing 'professional' care 'at home'. These standards vary across provinces.

In British Columbia, practice standards state that at times nurses may have to care for family or friends, but when possible care should be transferred to an appropriate care provider. Care of family members requires caution, discussion of boundaries and careful consideration about the impact of the dual role.

More information may be found at: http://www.crnbc.ca/downloads/432.pdf.

In Ontario, practice standards require recognition of the boundary between the nurse's professional and personal role and disclosure of this to the client. In caring for a family or friend a care plan must be developed and followed, as well as confidentiality maintained. When the nurse is not able to meet personal needs outside of the relationship, alternative caring arrangements must be found.

More information may be found at: http://www.cno.org/docs/prac/41033_Therapeutic.pdf.

In Nova Scotia, practice standards recognize the difficulty of avoiding family caregiving in small communities. Caring for family or friends is discouraged but when unavoidable, all effort should be made to separate the professional role from the personal role. When boundaries are blurred, it is recommended that another nurse step in to provide care.

More information may be found at: http://www.crnns.ca/documents/standards2004.pdf.

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KT FAQ

What is knowledge translation?

The Canadian Institutes of Health Research (CIHR), which is the primary funding agency for health research in Canada, defines 'knowledge translation' as "the exchange, synthesis and ethically-sound application of knowledge – within a complex system of interactions among researchers and users – to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products, and a strengthened health care system" (Canadian Institutes of Health Research accessed March 10, 2011).

CIHR makes a further discernment between the kind of KT that scholars are traditionally familiar with – the disseminations of findings via 'end-of-grant KT' – and a more inclusive, contemporary conceptualization of KT as integrated KT, wherein knowledge users and producers collaborate to develop a shared understanding of research needs and resources.

In the CIHR definition, and in this DDC-KT work, knowledge exchange is characterized by recognition that researchers and decision makers are normally separate groups with distinct cultures and perspectives on research and knowledge, with neither group fully appreciating the other's world. Knowledge exchange thus involves bringing together researchers and decision makers and facilitating their interaction, often beginning with a collaborative determination of the research question(s) (Graham et al., 2009).

Why is translating knowledge about double duty caregiving so important?

We believe that the Double Duty Caregiving Knowledge Translation Initiative is worthy of priority consideration for four reasons:

1. The knowledge that we're aiming to integrate into nursing practice and policy is derived from programmatic research that has developed over the course of a decade through exploratory, descriptive, critical, and mixed research methodologies.
   
   
2. The knowledge has consistently been derived in a fashion that integrates fifteen collaborators/knowledge users from coast to coast. Looking forward now to the dissemination and integration phases of this research program, collaborations with these knowledge users are poised to continue and expand as enthusiastic support and a commitment to move knowledge into action.
   
   
3. Finally, by fostering synergistic relationships and dialogue among nurses with vested interests in workplace practice issues, college and curricular mandates, and ministerial policy development, we have created the conditions necessary for well-rounded and shared interpretations of the evidence that will feed into the development and refinement of policy and practice implications.

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